Hypoparathyroidism
Parathyroid-related hypocalcemiaHypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).
Causes
There are 4 tiny parathyroid glands in the neck, located near or attached to the back side of the thyroid gland.
The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone.
Hypoparathyroidism occurs when the glands produce too little PTH. The blood calcium level falls, and the phosphorus level rises.
The most common cause of hypoparathyroidism is injury to the parathyroid glands during thyroid or neck surgery. It may also be caused by any of the following:
- Radioactive iodine treatment for hyperthyroidism
- Very low magnesium level in the blood
- Autoimmune attack on the parathyroid glands
Autoimmune
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 types of aut...
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DiGeorge syndrome is a childhood disease in which hypoparathyroidism occurs because all the parathyroid glands are missing at birth. This disease includes other health problems besides hypoparathyroidism.
Familial hypoparathyroidism occurs with other endocrine diseases such as adrenal insufficiency in a syndrome called type I polyglandular autoimmune syndrome (PGA I).
Symptoms
Onset of the disease is very gradual and symptoms can be mild. Many people diagnosed with hypoparathyroidism have had symptoms for years before they are diagnosed.
Symptoms may include any of the following:
- Abdominal pain
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
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Brittle nails
Nail abnormalities are problems with the color, shape, texture, or thickness of the fingernails or toenails.
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- Calcium deposits in some tissues
- Decreased consciousness
- Dry hair
- Dry, scaly skin
- Muscle cramps
- Muscle spasms called tetany (can affect the larynx, causing breathing difficulties)
- Pain in the face, legs, and feet
Pain in the face
Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or both sides.
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- Seizures
- Teeth that do not grow in on time, or at all
- Tingling lips, fingers, and toes
Tingling
Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...
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Exams and Tests
The health care provider will do a physical exam and ask about symptoms.
Tests that will be done include:
- PTH blood test
PTH blood test
The PTH test measures the level of parathyroid hormone in the blood. PTH stands for parathyroid hormone. It is a protein hormone released by the par...
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Calcium blood test
The calcium blood test measures the level of calcium in the blood. This article discusses the test to measure the total amount of calcium in your blo...
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Magnesium
A serum magnesium test measures the level of magnesium in the blood.
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24-hour urine test
The urine 24-hour volume test measures the amount of urine produced in a day. The amount of creatinine, protein, and other chemicals released into t...
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Other tests that may be ordered include:
- ECG to check for an abnormal heart rhythm
ECG
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Treatment
The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body.
Treatment involves calcium carbonate and vitamin D supplements. These usually must be taken for life. Blood levels are measured regularly to make sure that the dose is correct. A high-calcium, low-phosphorous diet is recommended.
Vitamin D
Vitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the body's fatty tissue.

Injections of PTH may be recommended for some people. Your doctor can tell you if this medicine is right for you.
People who have life-threatening attacks of low calcium levels or prolonged muscle contractions are given calcium through a vein (IV). Precautions are taken to prevent seizures or larynx spasms. The heart is monitored for abnormal rhythms until the person is stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth.
Outlook (Prognosis)
The outcome is likely to be good if the diagnosis is made early. But changes in the teeth, cataracts, and brain calcifications cannot be reversed in children who have undiagnosed hypoparathyroidism during development.
Calcifications
Calcification is a process in which calcium builds up in body tissue, causing the tissue to harden. This can be a normal or abnormal process....

Possible Complications
Hypoparathyroidism in children may lead to poor growth, abnormal teeth, and slow mental development.
Too much treatment with vitamin D and calcium can cause high blood calcium (hypercalcemia) or high urine calcium (hypercalciuria). Excess treatment may sometimes interfere with kidney function, or even cause kidney failure.
Hypercalcemia
Hypercalcemia means you have too much calcium in your blood.

Hypoparathyroidism increases the risk of:
- Addison disease (only if the cause is autoimmune)
- Cataracts
- Parkinson disease
Parkinson disease
Parkinson disease results from certain brain cells dying. These cells help control movement and coordination. The disease leads to shaking (tremors...
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Pernicious anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are man...
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When to Contact a Medical Professional
Call your provider if you develop any symptoms of hypoparathyroidism.
Seizures or breathing problems are an emergency. Call 911 or your local emergency number right away.
References
Clarke BL, Brown EM, Collins MT, et al. Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284-2299. PMID: 26943720 www.ncbi.nlm.nih.gov/pubmed/26943720.
Darr EA, Sritharan N, Pellitteri PK, Sofferman RA, Randolph GW. Management of parathyroid disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 124.
Thakker RV. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
Review Date: 5/17/2018
Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.